Abstract:
Background: Health care workers in Kenya have launched major strikes in the public health sector in the past
decade but the impact of strikes on health systems is under‑explored. We conducted a qualitative study to investi‑
gate maternal and child health care and services during nationwide strikes by health care workers in 2017 from the
perspective of pregnant women, community health volunteers (CHVs), and health facility managers.
Methods: We conducted in‑depth interviews and focus group discussions (FGDs) with three populations: women
who were pregnant in 2017, CHVs, and health facility managers. Women who were pregnant in 2017 were part of a
previous study. All participants were recruited using convenience sampling from a single County in western Kenya.
Interviews and FGDs were conducted in English or Kiswahili using semi‑structured guides that probed women’s
pregnancy experiences and maternal and child health services in 2017. Interviews and FGDs were audio‑recorded,
translated, and transcribed. Content analysis followed a thematic framework approach using deductive and inductive
approaches.
Results: Forty‑three women and 22 CHVs participated in 4 FGDs and 3 FGDs, respectively, and 8 health facility
managers participated in interviews. CHVs and health facility managers were majority female (80%). Participants
reported that strikes by health care workers significantly impacted the availability and quality of maternal and child
health services in 2017 and had indirect economic effects due to households paying for services in the private sector.
Participants felt it was the poor, particularly poor women, who were most affected since they were more likely to rely
on public services, while CHVs highlighted their own poor working conditions in response to strikes by physicians and
nurses. Strikes strained relationships and trust between communities and the health system that were identified as
essential to maternal and child health care.
Conclusion: We found that the impacts of strikes by health care workers in 2017 extended beyond negative health
and economic effects and exacerbated fundamental inequities in the health system. While this study was conducted
in one County, our findings suggest several potential avenues for strengthening maternal and child health care in
Kenya that were highlighted by nationwide strikes in 2017.